What Is A Spinal Headache? - Questions and Answers About
Spinal Headaches

1. What Causes An Spinal Headache?

A spinal headache is caused by leaking spinal fluid when the dura
which is the thin membrane that surrounds the spinal cord is punctured
by a spinal needle.
The fluid acts as a cushion around the brain and without it, the

brain tends to sag and rubs painfully against the bony skull. This brain
sagging causes stretching in the connective tissues in the cranium which
also causes pain. A further cause of pain is the loss of Cerebral Spinal
Fluid (CSF) which causes blood vessels in the brain to dilate.

2. How is a spinal headache different to other headaches?

Spinal headaches are typically postural headaches, meaning that standing or
sitting upright or even lifting your head will dramatically increase the
pain whereas laying down relieves the pain almost instantly.
Of course you can still
suffer from other types of headaches at the same time (tension headaches
and migraine headaches could be aggravated and therefore more frequent
because of the leaking spinal fluid, so it is possible to still have a
headache when you lay down).

Severe headache usually with sudden onset needs to be investigated
immediately because of the rare but real possibility of subdural
hematoma or meningitis. Also, a change
in headache for example where a headache which was previously relieved
by laying down suddenly appears regardless of position, a subdural
hematoma caused by bleeding on the brain needs urgent investigation
- "Of note, a change in headache pattern
should alert the physician to the possibility of development of
complications, such as subdural hematoma or cerebral venous thrombosis
(Lai et al 2007b; Schievink and Maya 2008). Please read
Norman's story

3. What is the Severity of
the Pain Associated with Spinal Headaches?

Spinal headaches can vary in
intensity from mild, moderate, but are often described as severe and
excruciating pain located in the sub-occipital region (back base of the
head) or bi-frontal (front of head). The headaches can be
incapacitating causing the sufferer to be bed-ridden and needing care.

4. What Relieves the
Pain of Spinal Headaches?

Caffeine will often temporarily
relieve the pain associated with the postural headache because it
increases the production of CSF (Cerebral Spinal Fluid) in the brain.
It is important to keep hydrated because this also helps to increase the
spinal fluid production. These methods are often the first line of
treatment to see if the leak will heal itself naturally. If the
headache is still there in 48 hours, a
blood
patch should be done. A blood patch will work 90% of the time,
sometimes another one is required.

5. What Other Symptoms Are
Associated With Spinal Headaches?

Other symptoms can include visual changes such as sensitivity to light
or double vision, nausea, neck pain, decreased hearing and tinnitis
(ringing in the ears).

6. What Are The Potential Complications Of Having A
Spinal Headache?

Left untreated, a spinal headache rarely can cause subdural hematoma
(caused by bleeding on the brain or brain hemorrhage)
due to stretching of the blood vessels resulting from
stretching and tearing of veins. Long term CSF leaking has also
been documented to have caused blindness. Very long term CSF leaks
have been documented to have caused dementia which was fixed through
surgery, these were not associated with spinal punctures, but dural
tears, nevertheless the same mechanism was responsible for the
complications.

Being in chronic and unrelenting pain has long term effects of it's
own including considerable stress and possible depression and for those
who have newborns to care for, this makes it extremely difficult.

7. How Long Will My Spinal Headache Continue?

Left untreated, a spinal headache will usually heal itself within
a few days. Unfortunately for some of us, they can also go on for
many months and will persist until the leak is closed either by blood
patch or surgical intervention (rare). There have been a couple of
reported cases of CSF leaks going on for years, but these were
associated with tears of the dura.

8. What Other Names Are There A Spinal Headache?

Postural headache, epidural headache, post dural
puncture headache, pdph, lumbar punture headache, low pressure headache,
intracranial hypotension, some people can get tears in their duras
through an accident or even spontaneously (spontaneous intracranial
hypotension). The leak can also be anywhere in the spine or head.
Leaking fluid from the nostrils can be a sign of csf leak somewhere in
the head, and this can cause meningitis. No matter what the cause,
these sort of headaches need medical attention.